# Optimizing Pain Management in End-Stage Renal Disease Among Veterans (OPERA-Vets):Balancing Benefits and Harms of Opioids

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Over the past decade, VA has implemented opioid policies, most notably the 2013 Opioid Safety
Initiative, designed to address the burgeoning opioid crisis. As the pendulum has swung away from opioid
prescribing, it is possible that some patients with serious illness may have experienced unintended
consequences, including uncontrolled pain, even while others may have avoided potential complications of
opioid use. This project examines the potential impact of these policies on Veterans with end-stage renal
disease (ESRD), a population of approximately 35,000 Veterans for whom balancing the benefits and harms of
opioids may be particularly challenging. These Veterans have very limited life expectancy and a substantial
pain burden, comparable to Veterans with metastatic cancer, but often under-appreciated. They are at
increased risk of opioid-related serious adverse events (SAE; e.g. opioid overdose). Yet compared with other
seriously-ill populations, they have fewer non-opioid analgesic alternatives to fall back on and may face
barriers to non-pharmacologic pain management strategies. Moreover, most Veterans with ESRD receive
dialysis in the community either under VA Community Care or Medicare, exposing them to the potential
adverse impact of care fragmentation on opioid safety and pain control.
Significance/Impact: Understanding the impact of VA initiatives to improve opioid safety at the population
level on Veterans with serious illness is critical to the VA’s commitment to ensure that these vulnerable
Veterans are provided care that relieves distressing symptoms. The work proposed here is responsive to the
VA Under Secretary for Health’s priority to improve pain management and the safety of pain medications.
Innovation: The proposed study is the first to examine the impact of opioid safety initiatives and prescribing
guidelines on a group of seriously-ill Veterans. It leverages VA data that include rich measures of pain control
unavailable from any other national data source. The use of a sequential explanatory mixed-methods study
design to triangulate quantitative and qualitative findings on pain management in the context of contemporary
opioid policy is a novel contribution to the field of opioid research.
Specific Aims: 1) Examine changes in pain management strategies, opioid-related SAE, and pain control
among Veterans with ESRD from 2010-2018; 2) Compare changes in opioid-related SAE by setting of dialysis
(VA, VA-Community Care, Medicare) from 2010-2018; 3) Elicit the perspectives and experiences of Veterans
with ESRD and the clinicians who care for them related to pain management in the context of VA opioid safety
initiatives in order to inform policy and practice.
Methodology: The study employs a sequential explanatory mixed-methods design. The quantitative portion of
the study (Aims 1 and 2) includes Veterans on dialysis across all VAs between 2010 and 2018. We will
conduct an interrupted time series analysis of linked VA, Me...

## Key facts

- **NIH application ID:** 10923830
- **Project number:** 5I01HX003282-04
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** MELISSA WACHTERMAN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-07-01 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10923830

## Citation

> US National Institutes of Health, RePORTER application 10923830, Optimizing Pain Management in End-Stage Renal Disease Among Veterans (OPERA-Vets):Balancing Benefits and Harms of Opioids (5I01HX003282-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10923830. Licensed CC0.

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